MCCL March Break Camp Registration
Student Name*

First Name

Last Name
Address*

Address 1


Address 2

Country

City

Province

Postal Code
Student Email*
Student Phone Number*
Preferred method of contact for Student*
School attended
Grade
Age*
Parent/Guardian Full Name*
First Name Last name
Parent/Guardian Phone #*
Parent/Guardian Email*
Preferred method of contact for Parent/Guardian*
Emergency Contact Name*
First Name Last Name
Emergency Contact Phone #*
Do you have any medical conditions or allergies we should know about?*
We will do our best to accommodate your needs for snacks.
What form of transportation will you use to get to/from the camp?
How did you learn about our camp?*
I give MCCL permission to use photos, videos, quotes belonging to me (Student registering)*


I would like to learn more about MCCL upcoming events and programming.*